| Teaching Students To Think
Like Physicians To learn to think like a
physician, students need to be put into situations in which they have to solve problems, make their reasoning
public, then receive feedback.
While diagnostic reasoning may be as simple as associating the correct cluster of signs
and symptoms with a diagnosis, students also need to practice the causal reasoning that
connects biological mechanisms with signs and symptoms. Students also need practice and
feedback on their reasoning involved with making short and long term treatment decisions.
This reasoning is often complex because it strategically incorporates the perspectives of
"best evidence" clinical science, insurance interests, patient and family
interests, and professional ethics. Morning report, rounds, and work on the ward provide
opportunities to provide constructive feedback on students’ diagnostic and treatment
reasoning.
Evaluating
Students’ Reasoning
To give effective feedback one needs
standards by which to judge the student’s reasoning process. What are the standards
by which students’ reasoning can be evaluated?
- Is the diagnosis correct or treatment plan appropriate? The
end point of the reasoning process is the starting point of critique and feedback. Even if
the student got it right, the more important question to the student is "How did you
arrive at that conclusion?"
- Is the reasoning logically coherent? Being able to state a
logical argument in which the components of the argument fit together is desirable rather
than encouraging an intuitive, almost unconscious pattern recognition that master
clinicians sometimes use.
- Are the facts in the argument correct and relevant? The
prevalence of a diagnosis, the anatomy and patho-physiology, etc., used in the argument
are either correctly recalled or not. Has the student selected only the facts that bear on
the problem and/or left out relevant facts, mechanisms, issues?
- What is the argument’s depth and breadth? Repeated
questions of "why" or "what causes that" will reveal the
student’s ability to think deeply, going to the cellular level perhaps, while asking
the student if there is another perspective that needs to be included reveals the
student’s breadth of reasoning.
Contrasted with the mindless ease of memorizing the
diagnostic and treatment routines of master clinicians, learning to reason is hard, often
uncomfortable work since students are constantly confronted with their uncertain mastery
of medicine. This is the price that needs to be paid so that the young clinician will be
able to more effectively and confidently address the areas of gray frequently posed by
patient’s problems. |
|
Suggestions for
Teaching Problem Solving
Effective problem solving is more than
just accumulating knowledge and rules; it is the development of flexible, cognitive
strategies that help analyze unanticipated, ill-structured situations to produce
meaningful solutions. Most problems present an ever-changing variety of goals, contexts,
contents, obstacles, and unknowns which influence how each problem should be approached.
To be successful physicians, students need to become skilled problem-solvers. Here are
some techniques that may help you to teach students how to effectively solve problems.
Step-By-Step Approach |
Ask
small questions along the way so that students can see how the solution is being arrived
at and can confront similar situations with the same strategy. |
Model Approach |
Model
the reasoning process by revealing your reasoning process in a step-by-step method. This
will reveal both your problem solving strategy and logic sequence. |
Encourage Questions |
Encourage
questions from your students and then avoid answering them directly. Make sure everyone
hears and understands the question and then start working on an answer as a team. |
Maintain Interaction |
If
you maintain a high degree of interaction with your students, they may be more willing to
participate and ask questions. The earlier in the clerkship that the students are
encouraged to talk, the more likely it is that they will contribute for the duration of
the clerkship. |
Multiple Approaches |
Have
students solve problems using both pattern recognition of signs and symptoms and a
hypothetico-deductive logic. This gives the students practice in both approaches to a
problem, and it may prevent mistakes. |
Formulate Problems |
To
help students develop their problem solving strategies as well as to find answers to
problems, present students with situations and encourage them to develop a series of
questions to find a solution. |
Ask Specific Questions |
Try
asking students specific questions about a representative problem to test for learning.
Students will often avoid responding to general questions such as "Does everyone
understand?" A more specific question will help you to determine how well the
students are understanding the information. |
Adapted by Nancy Plooster, University of
California, Santa Barbara, 1997 [On-line]. Adapted from information in Teaching at
Stanford: An Introductory Handbook for Faculty, Academic Staff/Teaching, and Teaching
Assistants, 1989. URL http://id-www.ucsb.edu/IC/TA/tips/prob.html. |
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